STD education essential, but public is reluctant

Be subtle in your attempts to draw a crowd

Although the United States has the highest rate of curable sexually transmitted diseases (STDs) of any developed country, Americans don’t want to hear about it — which offers a challenge akin to convincing today’s teenagers that smoking is bad or pregnancy is a grim possibility.

They don’t want to hear that the National Foundation for Infectious Diseases in Bethesda, MD, reports that five of the 10 most frequently reported nationally notifiable infectious diseases for 1995 were STDs. They don’t want to hear that these diseases include chlamydia, gonorrhea, AIDS, primary and secondary syphilis, and hepatitis B. And they most certainly don’t want to hear that health consequences of STDs range from mild acute illnesses such as pelvic pain to life-threatening conditions such as cancers of the cervix and liver.

STD education must ‘piggyback’

Yet, mindful of the statistics, government agencies are starting to stress the need for education efforts at the local level. The Institute of Medicine issued a report in November 1996 calling for a bold national initiative to reduce the enormous health burden of sexually transmitted diseases. Teens are especially susceptible because they are more likely to engage in unprotected sex and other high-risk sexual behaviors than adults, according to the report. One-quarter of the 12 million new STD cases each year occur among adolescents.Yet education is difficult because many STDs are symptomless, and people are often uncomfortable discussing them.

The challenge for patient educators is going to be how to implement STDeducation programs.

People think their sexual behavior doesn’t put them at risk, or they adopt an "it won’t happen to me" attitude, says Barbara Russell, RN, MPH, director of infection control services at Baptist Hospital of Miami. Community outreach seminars on STDs don’t draw much of a crowd. "If we have anything on STDs, we must promote it as something to teach your teenagers, and then once we get them in, explain that it can happen to anyone. We have to design the seminar so it doesn’t seem like people are attending because they personally need the information," she says.

What can patient education managers do? Here are a few ideas you can use to educate the public:

Piggyback STDs on AIDS awareness.

In Florida, HIV education is mandatory in grades K-12. Therefore, when nurses from Baptist Hospital are asked to lecture on AIDS, they include information on STDs. "Chlamydia is the number one cause of infertility in females and sterility in males in untreated cases. While it isn’t the same as getting a deadly disease like AIDS, it can have a serious impact when people decide to settle down and have kids. They might find out they can’t have children because of an untreated STD they got as a teenager," says Russell.

Screen patients when opportunities arise.

All prenatal patients using the women’s clinic at the Phoenix Indian Medical Center are screened for chlamydia, gonorrhea, and syphilis. If a lab report indicates that a patient tested positive for an STD, they are given a pamphlet and instructed on the disease, including information about transmission and prevention, says Ramona Joseph, MPH, the patient educator at the clinic. "We encourage them to bring their partners with them for the education. About 30% of the time their partners will come," says Joseph.

Create well-targeted outreach methods.

The Health Crisis Network in Miami, which was created to help people infected with AIDS and educate those who are not, trains teenagers to educate their peers. "Basically, the program teaches adolescents about HIV and STDs and encourages them to talk to their friends about it in their own language," says Amber Graham, MPH, coordinator for the Parent-Teen AIDS Prevention Project at the Health Crisis Network.

The 12-week training course, with three hour sessions scheduled twice a week, covers HIV, substance abuse, communication skills, decision making, STDs, and family planning. "All the information covered has a part in whether a young person becomes infected with HIV. If a teen has an alcohol problem, he or she is less likely to use protection when having sex. Teens with poor communication skills won’t know how to ask their partners to use a condom," says Graham.

Teens take part in community outreach efforts, passing out condoms or literature at the beach, popular malls, discos, concerts, and other events that attract teenagers. They also do presentations for schools and community groups. "One of the unique aspects of the program is the teen input," says Graham. "If there is an activity they don’t like, they tell us."

Focus on community outreach

Teens remain active in outreach efforts following their training, and currently the program has about 40 active teens. Since it was started two years ago, about 75 teens have been trained. Because of financial limitations, each training session is limited to 15 teen-agers. During training, they receive a 500-page copy of the curriculum, outreach materials, and a bus pass to travel to the training sessions and community outreach areas. All teens are eligible for the program if they have no conflicting obligations that would keep them from attending any of the training sessions.

Pass out STD information at health fairs.

Each year Baptist Hospital sponsors a women’s health day. The event features a big name speaker and a health fair. "We always have a table there with information about STDs and HIV. We notice that women are hesitant to come to our table — especially older women who will tell us they don’t need the information. We tell them to share the information with their children or grandchildren hoping they will take the material and read it," says Russell.

[To learn more about the teen training program at the Health Crisis Network write: Amber Graham, Health Crisis Network, Parent-Teen AIDS Prevention Project, 5050 Biscayne Blvd. Miami, FL 33137-3241. Telephone: (305) 751-7775. Fax: (305) 756-7880.]